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HELIOTHERAPY IN PULMONARY TUBERCULOSIS.
681 CASTOR OIL VERSUS SALINE APERIENT. To the Editor of THE LANCET. SiR,-In view of the concluding sentence of the note
SANATORIUM TREATMENT OF TUBERCULOSIS. To the Editor of THE LANCET.
under the above heading in THE LANCET of July 3rd, and of my experience of the very great value of castor oil in the early stages of acute bacillary dysentery, I submit the following figures in the hope that they may encourage further trials of this treatment.
annotation of Sept. llth (p. 560) on 3lessrs. Stocks and Karn’s inquiry into the value of sanatorium treatment for pulmonary tuberculosis refers to the surprising result, that amongst the patients dealt with those who have been in a sanatorium eventually fared worse than those who had not. There is, I think, a reasonable explanation. An average favourable case of pulmonary tubercle needs from one to two years’ treatment; and those who are stated to have been treated in a sanatorium seldom spend more than a few months of this time in the institution, all the remainder consisting of home treatment. The latter will have much more influence over the final result than the relatively short spell of sanatorium treatment; and as patients are sent to a sanatorium chiefly because the home conditions are unfavourable or unsuitable for some reason, those treated in a sanatorium will haveless favourable home conditions than those treated entirely at home, and will show correspondingly poorer results. The contrast will be greater in proportion to the unsuitability of the home ; and will be less amongst really early favourable cases, because these will be more completely restored in the short time available for sanatorium treatment. We may conclude, not that sanatorium treatment is waste of time and money, but that really favourable cases should receive prolonged treatment, first at a sanatorium and then in a radically reformed home. In proportion as the latter is made to resemble hygienically a good sanatorium, so will the time necessary for sanatorium treatment be reduced and the damage of subsequent relapse diminished. I do not wish to minimise the value of the inquiry referred to, but to prevent fallacious conclusions being drawn I am, Sir, yours faithfully, therefrom.
SIR,—Your
Between October, 1921, and September, 1922, I treated 183 Kenya natives mainly with salines ; the death-rate was 18-6 per cent. Between October, 1922, and March, 1924, I made use of the castor-oil treatment for 205 Kenya natives with a death-rate of 4-9 per cent; most of these deaths, however, occurred early in the series, when I had not found out how best to apply the treatment. In my last 96 cases there has been one death ; in most of these cases I have given two complete courses of castor oil after mucus had ceased to appear in the stools ; I find that relapses, few as they were previously, are now fewer.
Full particulars of this treatment, its rationale, and results are given in an article in the Kenya Medical Journal (August, 1924) by myself and my valued late assistant, Mr. C. J. Mascareuhas, to which Dr. Boase most kindly refers in his letter in THE LANCET of July 10th. Possibly liquid paraffin would prove as useful as castor oil, which, in the doses and frequency required, is tolerated only with difficulty by most Europeans.—I am, Sir, yours faithfully, T. B. WELCH, M.B., D.T.M. & H., Medical Superintendent, Chacachacare Leper Settlement. Trinidad, August 24th, 1926.
HELIOTHERAPY IN PULMONARY TUBERCULOSIS. To the Editor of THE LANCET. S[R,—I have followed with interest Dr. J. E. Wood’s article and Dr. F. G. Chandler’s letter on this subject. The conditions for heliotherapy at Montana are practically identical with those at Leysin and we are using this treatment more and more extensively in pulmonary cases. With febrile patients the amount of exposure has to be so small and the time required for pigmentation is so long that sun-baths are rarely employed. Short air-baths on the feet and legs are more useful in such cases. Sun-baths are only used extensively when the temperature has been brought down to normal by rest, artificial pneumothorax, sanocrysin, or other means. The majority of afebrile patients benefit from heliotherapy, but dangerous reactions are liable to follow faulty technique, especially too early exposure of the diseased part. To avoid this danger the following method is used. The feet, legs, and abdomen are exposed according to Rollier’s technique. About a month later, when these parts are sufficiently pigmented, the chest is first exposed for two to five
F. R. WALTERS.
TUBERCULIN DISPENSARIES. ’1’0 the .ba1tor
of THE LANCET. SiR,-Will you kindly allow me to ask through the medium of your columns if perchance there is now a tuberculin dispensary in Brighton where a patient going out from Rudgwick Sanatorium may receive treatment with tuberculin on the intensive system, as taught by Dr. Camac Wilkinson in 1910 and following years. I can hardly imagine a place of the size and importance of Brighton not having a public tuberculin dispensary, and there must surely be some of the many doctors there who are proficient in the method, but I cannot find anyone who is known to be an expert in this treatment. I, personally, havefollowed out his method of treatment ever since we opened our Clapham Tuberculin Dispensary in April, 1911, and am more than convinced that up to the present time no other treatment can giveanything like such good results, and I have worked at Rudgwick ever since 1898. If this treatment is begun early about 90 per cent. recover completely and that without having to give up their daily work, which is so important. In London, now that Dr. Camac Wilkinson has returned, this early treatment may be obtained at 32, Fitzroy-street, Fitzroy-square, Tottenham Courtroad, W.C., on Mondays and Thursdays at 9-11 A.M., and doctors are all welcomed to come and learn it; but other towns should surely be able to work out such a system. so that patients everywhere may get the
minutes. The time of exposure is increased gradually As a rule it is not wise to up to one to two hours. give more than two hours’ exposure to Alpine sunlight in pulmonary cases. Rollier’s practice in avoiding sun-baths when the air temperature is high should be carefully observed. In summer the early morning for heliotherapy. In Iiwinter hours give the best conditions sun-bathing may be carried out at any time of day as the air temperature is always low and the intensity of the sunlight is increased by reflection from the snow. Although much less striking than in surgical cases, the results so far obtained are encouraging. Besides increasing the appetite and improving the nutrition of skin and muscles, heliotherapy has a psychic effect which is often of considerable benefit. Recently the benefit.-I am, Sir, yours faithfully, treatment of surgical tuberculosis has been copied ANNIE MCCALL, M.D., &c., still further, and with certain cases hydrotherapy has Chairman and Director of Clapham Maternity been added to heliotherapy. In a few of the more Hospital and Affiliated Institutions. robust patients this combination of sun- and lakeClapham-road, London, S.W., Sept. 21st, 1926. a beneficial effect. **its there any reason to doubt that the facilities bathing appears to have I am, Sir, yours faithfully, for the treatment advocated will follow upon the ANDREW MORLAND. general acceptation by the medical profession of their Palace Sanatorium, Montana, Switzerland, needed. L. Sept. 17th, 1926.
I
r.
I
SANATORIUM TREATMENT OF TUBERCULOSIS. To the Editor of THE LANCET.
under the above heading in THE LANCET of July 3rd, and of my experience of the very great value of castor oil in the early stages of acute bacillary dysentery, I submit the following figures in the hope that they may encourage further trials of this treatment.
annotation of Sept. llth (p. 560) on 3lessrs. Stocks and Karn’s inquiry into the value of sanatorium treatment for pulmonary tuberculosis refers to the surprising result, that amongst the patients dealt with those who have been in a sanatorium eventually fared worse than those who had not. There is, I think, a reasonable explanation. An average favourable case of pulmonary tubercle needs from one to two years’ treatment; and those who are stated to have been treated in a sanatorium seldom spend more than a few months of this time in the institution, all the remainder consisting of home treatment. The latter will have much more influence over the final result than the relatively short spell of sanatorium treatment; and as patients are sent to a sanatorium chiefly because the home conditions are unfavourable or unsuitable for some reason, those treated in a sanatorium will haveless favourable home conditions than those treated entirely at home, and will show correspondingly poorer results. The contrast will be greater in proportion to the unsuitability of the home ; and will be less amongst really early favourable cases, because these will be more completely restored in the short time available for sanatorium treatment. We may conclude, not that sanatorium treatment is waste of time and money, but that really favourable cases should receive prolonged treatment, first at a sanatorium and then in a radically reformed home. In proportion as the latter is made to resemble hygienically a good sanatorium, so will the time necessary for sanatorium treatment be reduced and the damage of subsequent relapse diminished. I do not wish to minimise the value of the inquiry referred to, but to prevent fallacious conclusions being drawn I am, Sir, yours faithfully, therefrom.
SIR,—Your
Between October, 1921, and September, 1922, I treated 183 Kenya natives mainly with salines ; the death-rate was 18-6 per cent. Between October, 1922, and March, 1924, I made use of the castor-oil treatment for 205 Kenya natives with a death-rate of 4-9 per cent; most of these deaths, however, occurred early in the series, when I had not found out how best to apply the treatment. In my last 96 cases there has been one death ; in most of these cases I have given two complete courses of castor oil after mucus had ceased to appear in the stools ; I find that relapses, few as they were previously, are now fewer.
Full particulars of this treatment, its rationale, and results are given in an article in the Kenya Medical Journal (August, 1924) by myself and my valued late assistant, Mr. C. J. Mascareuhas, to which Dr. Boase most kindly refers in his letter in THE LANCET of July 10th. Possibly liquid paraffin would prove as useful as castor oil, which, in the doses and frequency required, is tolerated only with difficulty by most Europeans.—I am, Sir, yours faithfully, T. B. WELCH, M.B., D.T.M. & H., Medical Superintendent, Chacachacare Leper Settlement. Trinidad, August 24th, 1926.
HELIOTHERAPY IN PULMONARY TUBERCULOSIS. To the Editor of THE LANCET. S[R,—I have followed with interest Dr. J. E. Wood’s article and Dr. F. G. Chandler’s letter on this subject. The conditions for heliotherapy at Montana are practically identical with those at Leysin and we are using this treatment more and more extensively in pulmonary cases. With febrile patients the amount of exposure has to be so small and the time required for pigmentation is so long that sun-baths are rarely employed. Short air-baths on the feet and legs are more useful in such cases. Sun-baths are only used extensively when the temperature has been brought down to normal by rest, artificial pneumothorax, sanocrysin, or other means. The majority of afebrile patients benefit from heliotherapy, but dangerous reactions are liable to follow faulty technique, especially too early exposure of the diseased part. To avoid this danger the following method is used. The feet, legs, and abdomen are exposed according to Rollier’s technique. About a month later, when these parts are sufficiently pigmented, the chest is first exposed for two to five
F. R. WALTERS.
TUBERCULIN DISPENSARIES. ’1’0 the .ba1tor
of THE LANCET. SiR,-Will you kindly allow me to ask through the medium of your columns if perchance there is now a tuberculin dispensary in Brighton where a patient going out from Rudgwick Sanatorium may receive treatment with tuberculin on the intensive system, as taught by Dr. Camac Wilkinson in 1910 and following years. I can hardly imagine a place of the size and importance of Brighton not having a public tuberculin dispensary, and there must surely be some of the many doctors there who are proficient in the method, but I cannot find anyone who is known to be an expert in this treatment. I, personally, havefollowed out his method of treatment ever since we opened our Clapham Tuberculin Dispensary in April, 1911, and am more than convinced that up to the present time no other treatment can giveanything like such good results, and I have worked at Rudgwick ever since 1898. If this treatment is begun early about 90 per cent. recover completely and that without having to give up their daily work, which is so important. In London, now that Dr. Camac Wilkinson has returned, this early treatment may be obtained at 32, Fitzroy-street, Fitzroy-square, Tottenham Courtroad, W.C., on Mondays and Thursdays at 9-11 A.M., and doctors are all welcomed to come and learn it; but other towns should surely be able to work out such a system. so that patients everywhere may get the
minutes. The time of exposure is increased gradually As a rule it is not wise to up to one to two hours. give more than two hours’ exposure to Alpine sunlight in pulmonary cases. Rollier’s practice in avoiding sun-baths when the air temperature is high should be carefully observed. In summer the early morning for heliotherapy. In Iiwinter hours give the best conditions sun-bathing may be carried out at any time of day as the air temperature is always low and the intensity of the sunlight is increased by reflection from the snow. Although much less striking than in surgical cases, the results so far obtained are encouraging. Besides increasing the appetite and improving the nutrition of skin and muscles, heliotherapy has a psychic effect which is often of considerable benefit. Recently the benefit.-I am, Sir, yours faithfully, treatment of surgical tuberculosis has been copied ANNIE MCCALL, M.D., &c., still further, and with certain cases hydrotherapy has Chairman and Director of Clapham Maternity been added to heliotherapy. In a few of the more Hospital and Affiliated Institutions. robust patients this combination of sun- and lakeClapham-road, London, S.W., Sept. 21st, 1926. a beneficial effect. **its there any reason to doubt that the facilities bathing appears to have I am, Sir, yours faithfully, for the treatment advocated will follow upon the ANDREW MORLAND. general acceptation by the medical profession of their Palace Sanatorium, Montana, Switzerland, needed. L. Sept. 17th, 1926.
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